Provider Demographics
NPI:1053811232
Name:MAHADIK, RASIKA (COTA)
Entity type:Individual
Prefix:
First Name:RASIKA
Middle Name:
Last Name:MAHADIK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 OAKLAND CT
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-3109
Mailing Address - Country:US
Mailing Address - Phone:862-224-6075
Mailing Address - Fax:
Practice Address - Street 1:540 W HANOVER AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-2500
Practice Address - Country:US
Practice Address - Phone:973-270-9492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-14
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009539-1224Z00000X
NJ46TA09155700224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty